A large number of persons have varying degrees of upper airway obstruction presenting with varied degrees of symptoms. As the upper airway begins with the nose and mouth, it is not surprising that the nose, tongue, and jaw all make contributions to such obstructive syndromes.
Various treatment modalities have been suggested. Various airway pressure devices, such as continuous positive airway pressure devices (CPAP) have been successfully used, although these tend to be both cumbersome and uncomfortable. More recently, dental orthotics have been employed. One general class of orthotic relies upon shifting the position of the lower jaw, generally moving the jaw forward, to displace the tongue anteriorly and thereby help clear the upper airway. Obviously, it is difficult to shift the jaw anteriorly without an external anchor point, so these orthotic have also presented problems of utility and comfort.
A classical means for advancement of the jaw is the Herbst appliance, shown in general form in FIGS. 1 and 2. The Herbst appliance is a fixed, tooth-borne, functional orthodontic appliance in which jaw position is influenced by a pin-and-tube spring-loaded appliance that is cemented or bonded to the teeth.
In particular, the Herbst appliance, or Herbst-type orthotics, often suffer from a number of practical problems. Generally, these devices are semi-permanently bonded to the teeth, and while they can be removed by a practitioner, they are not generally amenable to removal by the wearer. These appliances generally cannot be adjusted as to strut length, and thus degree of jaw advancement, without removing the appliance from the mouth of a wearer.
Another class of orthotic, and in particular that described by Robson (U.S. Pat. No. 5,752,822) relies on positioning the tongue on an extension that elevates the tongue and causes the tongue to move forward to an upward position resting on the extension. These devices are designed to manipulate the airway by changing the position of the tongue.